Folks Without Book Learnin' are Entitled to Medical Opinions

Folks without book learnen'
I think the "They" syndrome is bcoming more and more common as life gets more and more complicated. It's a hell of a lot easier to blame "Them" than to check out a fact.

I did graduate the 8th grade!

Re: Folks Without Book Learnin' are Entitled to Medical Opin


I think there are a few things left out of it. I don't think most of these peopel think they know better than the doctors do. In many cases there are licensed doctors that are leading the charge. There are quite a few medical professionals that beleive the thimerasol/autism link is real.

I also don't think it a matter of it being a democracy and everyone having an opinion. The medical establishment has been encouraging people to "get involved" in the medical decisions that affect their lives. Most of the people that believe this sort of stuff ARE getting involved. They are no more (or less! ) nuts that those that think red meat is always bad for you, that genetically modified crops are to blame for the downfall of the western hemisphere or that any non-organic foods will cause cancer. All things in moderation.

I only can relate to my own experience and I would say this:

- Doctors are exactly like electricians or plumbers, I know a lot of bad ones.

- Some of my friends are doctors and some are no more friends. I've seen some of them making prescriptions so much inadequate to the symptoms that I'd to ask them why they did so. The answers were so out of logic that I felt sorry for the patient. And I've seen the results: ugly!

- I'd also seen ignorance at work: a doctor in a difficult situation crying because he didn't know what to do. I told him (pure logic).

Now I'm more than circumspect...

I think part of the problem is that sometimes the concerned non medical folk are proved correct!

Medicine is part science, which has its own cycle of prejudices and influences (anyone SEEN the constant barrage of stuff that doctors are more or less bribed to give you by the drug companies?) and part art.

Lots of things that doctors do make almost no sense..REALLY! And they often, for instance, fail to do simple things that WOULD make a huge difference (like wash theur hands between patients...TRUE! Doctors and nurses failing to wash their hands is a fairly major source of cross infection in hospitals, causing hospitals to run frequent campaigns about it.)

Sometimes it is very difficult to get real dangers attended to..........look at thalidomide.

The "natural" health industry was very concerned re hormone replacement therapy....with good reason, as it happens...though whether their reasons were the ones which turned out to be operating is a whole other question!


Drugs are released which DO turn out to be very dangerous.....



Counter to this, the net is like a huge, instantaneous rumour mill....or like a mob. And people down the ages have loved a good scare, or a damned fine mob outing.

How many of us have any good idea of how to read "evidence"? Of how to pick apart data that is presented to us?


Doctors are trained in this, but they are just human.


Personally, if I have concerns, I do not really trust either side, but question my doctor very closely, and do my best to weigh up evidence I can find.


BTW, the vaccination thing is a good example (and I am just going from memory here, so may turn out to be wrong) of data that is easily misread.


As I recall, there WAS a correlation between vaccinations, and increase in autism in a number of countries. Thing is, that does not prove causation, as we all know....then I think there was data from countries with no vaccination change, but still with the rise in autism




Be good if we taught critical scientific thinking better, eh?

I grew up in the era when a doctor told you to do something, you did it, without question.
For those of us who can remember that far back, prescriptions did not even come with the names of the medications on them, The bottle said, "Take three times a day for cough" or some similar thing. The pharmacist never gave you a print out of the medication, what it does, and its side effects. Doctors treated patients like children. In fact, I have heard jokingly, that in the old days, M.D. stood for "medical deity".

Over the years, this has changed dramatically. Patients have become "consumers of medical services". Because of the way that medical service is now dispensed, it is absolutely essential that the patient needs to be a partner with his doctor in matters concerning his care. Doctors so not know their patients like they did in the past. They no longer have the time to spend with their patients (that could be the focus of a whole other thread) like they used to.

I have made it my business to become very knowlegable about medications, ailments, surgeries, and other issues relating to medicine. I would suspect that I know quite a bit more than the average young doctor.
I feel that in today's society it us a necessity, and can literally mean the difference between life and death.

I will learn about something, and question my doctor when I disagree with an assessment. I have been proven correct on more than one occasion.

I am so in agreement with you Francis. I have worked in a medical environment almost all of my adult life. I shudder whenever I see some people who put such trust in some of the doctors I know that I wouldn't entrust with a dead cat.

There's that old joke...

What do you call someone who graduated last in class in medical school?

Answer: Doctor

That is so true. I trust my and my husbands doctors because I have checked on them and keep them on their toes with questions for which I won't accept vague answers.

I have fired one doctor that I know of.

Good post Francis.

I have an abiding mistrust of the entangling of drug companies, the federal govt and doctors. Rarely will I go to the doctor, though a darn good doctor one time saved my life. It depends on the malady and how serious it seems before I will go.

Interesting question and interesting replies.

I've always thought that my doctor knows more about medicine than I do but that I know more about me than she does. I ask a lot of questions but I trust her advice. If I didn't I'd find another doctor.

My current doctor and my last two doctors are from India. They have all seemed to take a very holistic approach to medicine and I like that. They don't prescribe a lot of stuff.... well.... other than excercise. They precscribe that a lot and for a large variety of problems. I don't know if being from India is what makes the difference but, it has seemed to hold true.

There was a thread on A2K today where someone was discussing their new prescription to Prozac. They were thinking that if 20mgs made them feel better then 40mgs would make them feel great.

I believe that kind of thinking is very common and very scary.

Similar situations arise with the law. And the legal profession has, in many ways, completely shot itself in the foot (I realize this isn't about the law, but it's a similar professional structure, with licensed professionals, paraprofessionals and laypersons). With the legal profession, the shooting in the foot occurred when paralegal training and licensure was not standardized. Hence many firms can and do try to pass off secretaries as paralegals. Sorry, but typing a motion is not the same as writing one. I am well aware that people often compose while reviewing (I certainly do), but I have been in a lot of law firms and dug deeply into records and asked a lot of questions and the bottom line is that not everyone who is called a paralegal should be. I taught paras at NYU, and most of the students wanted to go to Law School anyway, but at least they were getting an education. For any number of paralegals, however, their education is barely this side of observations. And some of them are very good -- I don't dispute that. But a lot of them aren't, and a lot of firms push the definition to the limit. Hence you get overcharges up the wazoo.

With medicine, however, at least there is licensure for RNs. It's a certain amount of education, offered by accredited schools. And hence RNs have a trustworthy level of professional training. This does not mean that they are all wonderful, of course, but it does mean that they have passed minimal competency tests and practicums (practica?).

But for both professions, a lot of the problems seem to stem from laypersons getting on the 'net and misinterpreting what they read because they have no context, but it's not just that, it's also the colloquial linguistic world collides with the professional, term of art linguistic world. When those worlds collide, laypersons think they might understand something, but they don't.

In the colloquial world, an article might read: "The magazine was sued for slanderous comments." But the reality in professional legal land is that that's impossible unless those were oral statements, because slander is oral speech and libel is written speech, so the article should have read: The magazine was sued for libelous comments." Same thing in the medical world. When we say, "He has epilepsy." that can actually cover any number of ailments, including some disorders where the main symptom is seizures but the underlying cause is something far different, such as a brain tumor. Look at all of the sound and fury that surrounded the Schaivo case, in terms of who is brain dead. In the medical community, that's a term of art that has certain meanings, and perhaps those meanings are in flux (after all, as a part of the greater scientific community, medical theories can and are often changed as new evidence comes to light) but they aren't necessarily the same as what we say colloquially.

Look at all of the other extremely complex medical conditions there are. How 'bout obesity? Why are people overweight? How can they lose weight? How can they keep it off? There are theories, sure, and I'm sure we all realize that poor diet and lack of exercise are a big part of that, but we also probably all know someone who eats like a horse and never gains a pound, or eats like a bird and is large, or who is heavy but strong or graceful, etc. And there are no easy answers to these questions because the medical community itself isn't too sure.

We also see this in the media, and not just in journalism, but also in entertainment. It's big entertainment, these days, to watch autopsy-style criminal investigations. And people buy into this as being real medical knowledge, hook, line and sinker. I can't speak for medical "facts" being thrown out there by dramas and sitcoms, but I can tell you for sure that most legal "facts" are wrong, wrong, wrong or are riddled with so many exceptions and distortions as to be unusable. So I figure most of the medical "info" out there in fictional shows is just that -- fiction. But not everyone understands the difference. And, even when it isn't fiction, even when it's journalism, I think a lot of folks also don't get the fact that they are being spoon-fed simplistic information that is incomplete because the medical segment has to fit into 18 minutes of a longer show and be palatable to a mainstream audience.

There's incomplete information, and there's a lack of critical thinking going on, on the part of much (not all) of the audience. How many people understand bias in what they read and hear? How many understand that writers and journalists can have an agenda? Spin, anyone? If you want to see 'net spin in action, just look up "global warming" on Google.

There's a lot of info out there, and some of it is good. If it gets people to ask good questions or prod their doctors to try new things, then it's a good outcome. But unfortunately, the information as presented isn't understood, it has little context, and I think people extrapolate to what they really want to read and hear.

I, too, read the topic about doubling the Prozac dosage, and it scared the heck outta me. I am not saying that every expert is perfect and a healthy skepticism is a good thing, but there's a reason for a doctor's education and training, and if you haven't had either, you might want to step back and think about what that means in terms of how much weight should be given to your own theories and opinions. It doesn't mean that the doctor or lawyer is lord of all he or she surveys. Far from it. But at the same time, it does mean that the info you get might not be fully understood by you. A little knowledge is a dangerous thing, and in this area, that old saw is more than a little true.

Jes- I hear what you are saying about "a little knowledge", but like anything else, a person with a modicum of intelligence can become as knowledgeable as he wants about a subject.

I think that with medical issues and the internet, a person needs to understand which websites are bogus, which can be trusted, and the myriad of others in between. For myself, I tend to read the professional websites, rather than the ones geared to lay people. Yes, it takes more work, because one has to familiarize oneself with medical terminology, but it certainly can be done.

Years ago, (I have been doing this for a long, long time) I bought a medical textbook, that was geard to medical students. This was in the 1970's, long before the internet was a gleam in Bill Gates' eye. I was looking up a medical condition. The first time that I read it, I had no idea of what the author was saying. Second reading, and still nothing. I then read it with a medical dictionary at my side. After a few readings, I knew exactly what the author was trying to convey.

Is it work? Sure. It is much less work now, because of the internet. I have a program from answers.com, so I can look up a word while I am reading an article. Makes it much easier.

Why do I bother? It's my life, I am responsible for it, and I want to know as much about how it works as possible. It is well worth the extra effort.

That is an excellent analogy, jespah.

Well, that's the thing. How many people want to put the time and effort in? We're used to getting stuff asap and folks need to stop and think about the info they are getting, the source, and whether they actually understand it. Few do.

Jes- Exactly. Many people out there are intellectually "sloppy", on many issues, besides medical or legal. It is their choice. I think though, that if an issue is important enough to you, that it is wise to put the time and effort into learning as much as you can about it.

Only one?

HA! Amateur!!!

My general doctor knows better than to walk into an examining room and give me any diagnosis without bringing literature. He knows I'm going to check up on whatever he says. And if he refers me to someone, he knows I'll do the same thing AND tell him what I thought of the referral. I think this is why he always refers me to the top people now.

Yep.

I've had one outright horror story and a few "Hmmm, I don't think so" experiences with doctors just since sozlet was born. (As in, a lot more stuff before that, especially around when I lost my hearing. Still not clear what happened exactly but one thing that is certain is that I was prescribed and took a medication [Diamox] that was itself ototoxic for many years, and that my hearing leveled off -- stopped its downward decline -- when I stopped taking it.)

I've "fired" in the sense of moved on to another doctor... a lot of times.

Jerome Groopman and Atul Gawande are two doctors who have written in the New Yorker and I think the NYT too, really fantastic, in-depth explorations of this subject directly and indirectly. Jane Brody in the NYT has talked about it, too. I wish I could remember some specifics, but a general impression from that body of work is that doctors are highly fallible and we, as patients (or parents-of), have a responsibility to be informed. Jane Brody has gone into this with particular heat re: pain relief lately. (Doctors are often clueless about proper pain relief, too scared of the narcotic aspect.)

I love a good, peer-reiviewed, double-blind study, and will tend to trust it (or a few of them) over the opinions of an individual doctor.

List of articles by Jerome Groopman, with active links to the articles:

http://www.jeromegroopman.com/articles.html

Atul Gawande:

http://www.hsph.harvard.edu/faculty/AtulGawande.html

Just titles, no active links, but the titles give you a flavor. (His book is "Complications: A Surgeon's Notes on an Imperfect Science.")

A random but typical excerpt of "don't panic, but don't be too trusting" kinds of things he writes:



Jane Brody on pain control (recent):

http://www.deathwithdignity.org/voices/opinion/newyorktimes.01.10.06.asp:

I don't know how it is in your state, but in Florida, apparently doctors who are certified in "pain management" have an easier time of it in prescribing narcotics. My husband has a problem with severe chronic headaches brought on by overzealous ENTs who went a bit overboard on his many sinus surgeries.

The internist tried everything...................being allergic, my husband became quickly sensitized to the drugs that they prescribed, which gave him even a worse headache. Anyhow, he discovered that Lortab, a narcotic medication, in small amounts, gives enough pain relief to make life bearable.

His internist doled it out like the pills were gold nuggets. At one point he made the remark to my husband, "If you were my cousin, the law would be after me".

My husband finally went to a pain clinic, and was able to get what he needed. Every time he went to the pain doctor though, he had to fill out this intricate form which described the site and intensity of his pain, and sign the form.

That's not one I've had any personal experience with, thank goodness, just have been reading Jane Brody's interesting columns on the subject. (She's in New York, I believe.)